Revenue cycle advisory

Revenue cycle management built for GCC e-claims platforms

Eligibility, coding, e-claims and denial recovery tuned for eClaimLink, Shafafiya and NPHIES.

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In the GCC, almost every insured encounter ends as an electronic claim: through eClaimLink and DHPO in Dubai, Shafafiya in Abu Dhabi, or NPHIES in Saudi Arabia. Each platform has its own validation rules, coding expectations and resubmission windows, and each insurer or TPA adds its own contract terms. Revenue cycle management is the discipline of getting all of that right, from the moment a patient books to the moment the remittance is reconciled.

Revenue cycle management is where Dr. Neeraj Puranik has spent much of his 18+ years. Tulazai Health audits your cycle end to end, finds where money is lost (eligibility gaps, missing prior authorisations, coding errors, unworked rejections, unreconciled remittances) and fixes the process behind each leak. We can advise your in-house team, rebuild it, or oversee an outsourced partner on your behalf.

What changes for you

  • Fewer claims rejected at first submission
  • Denials worked and resubmitted within payer windows
  • Remittances reconciled against contracted prices
  • A billing team that knows its own numbers

Scope

What the engagement covers

01

End-to-end RCM audit

A sample-based review of encounters from registration to remittance, identifying where claims fail, what the root causes are and how much value sits in unworked rejections and underpayments.

02

Front-end eligibility and prior authorisation

Registration scripts, eligibility checks and prior authorisation workflows redesigned so coverage, benefits and approvals are confirmed before treatment, not discovered after the claim is rejected.

03

Clinical documentation and coding review

Coding accuracy reviewed against ICD-10-CM and CPT in the UAE, or ICD-10-AM and the Saudi Billing System in KSA, with documentation feedback for doctors and targeted coder training.

04

E-claims submission and scrubbing rules

Claim validation rules configured and tested for eClaimLink and DHPO, Shafafiya or NPHIES, so formatting, code pairing and mandatory field errors are caught before the claim leaves your system.

05

Denial management and resubmission

A categorised denial log, root-cause analysis by payer and reason, resubmission templates and a daily work queue, so every rejection is either recovered or consciously written off within the payer's deadline.

06

Contract loading and remittance reconciliation

Payer price lists and contract terms loaded accurately into your HIS, and remittance advices reconciled line by line, so underpayments are identified and disputed rather than silently absorbed.

Process

How the work runs

Clear stages, named owners and a written plan at every step, so you always know what happens next.

  1. Baseline

    We extract claims, rejection and remittance data by payer and establish your current rejection patterns, ageing profile and cash conversion before recommending anything.

  2. Root-cause analysis

    Every major rejection category is traced back to its true source: registration, authorisation, clinical documentation, coding, system configuration or contract loading.

  3. Fix the process

    Workflows, system rules, templates and training are corrected at the source, starting with the causes that account for the largest share of lost revenue.

  4. Recover the backlog

    In parallel, recoverable rejections and underpayments still inside payer resubmission windows are worked in priority order, so the project starts paying back early.

  5. Monitor and hand over

    A weekly RCM dashboard and review routine are handed to your team, with optional ongoing oversight of an in-house or outsourced billing function.

Who this is for

Hospitals

Operations, revenue cycle and payer strategy for private hospitals across the GCC.

Clinics

Setup, licensing, insurance and billing support for single and multispecialty clinics.

Medical Centres

Payer networks, revenue cycle and multi-site operations for medical centres and groups.

Home Healthcare

Licensing, workforce, insurance and operating models for home healthcare providers.

Where we deliver Revenue Cycle Management

Revenue Cycle Management · United Arab Emirates Revenue Cycle Management · Dubai Revenue Cycle Management · Abu Dhabi Revenue Cycle Management · Sharjah Revenue Cycle Management · Saudi Arabia Revenue Cycle Management · Riyadh Revenue Cycle Management · Jeddah Revenue Cycle Management · Dammam Revenue Cycle Management · Qatar Revenue Cycle Management · Doha United Arab EmiratesSaudi ArabiaQatarOmanBahrainKuwait

Frequently asked questions

What does revenue cycle management include for a GCC clinic or hospital?
Revenue cycle management covers every step that turns a patient visit into collected cash: registration, eligibility checks, prior authorisation, clinical documentation, coding, e-claim submission, rejection handling, resubmission, remittance reconciliation and payer follow-up. In the GCC these steps run through regulated platforms such as eClaimLink and DHPO, Shafafiya and NPHIES, so both process discipline and platform knowledge matter.
Do you handle NPHIES and Saudi Billing System coding in KSA?
Yes. For providers in Saudi Arabia we review NPHIES workflows for eligibility, prior authorisation and claims, and check coding against ICD-10-AM and the Saudi Billing System coding standards set by CHI. We also help map internal service codes to the standard code sets that NPHIES transactions require, which is often where new or growing providers lose revenue.
Is this outsourced billing or consulting?
Our core service is consulting and oversight: we diagnose the cycle, fix processes, train your team and set up monitoring. If you prefer to outsource billing, we can help you select a partner, define service levels and then audit that partner on your behalf. Either way, you keep visibility of your own revenue data.
How quickly can we see results from an RCM engagement?
Backlog recovery on rejections still inside resubmission windows can start within the first weeks. Process fixes at registration, authorisation and coding usually show in rejection trends within one to three claim cycles, depending on payer turnaround times. We track these movements weekly so you can see what is changing rather than waiting for a final report.
Can you help with Abu Dhabi DRG and Shafafiya requirements?
Yes. Inpatient care in Abu Dhabi is reimbursed on a DRG basis, which makes the quality of clinical documentation and coding directly visible in payment. We review inpatient documentation, coding and Shafafiya submissions, and we work with doctors and coders on the documentation gaps that most often affect grouping and reimbursement.

Related services

Insurance Empanelment & Networking

Get listed with the right insurers and TPAs, on tariffs and terms your facility can live with.

Healthcare Operations Consulting

Patient flow, staffing, SOPs and KPIs redesigned so your facility runs on process, not on heroics.

Digital Health & Healthtech Advisory

EMR selection, NABIDH, Malaffi and NPHIES integration, telehealth and GCC market entry for healthtech.

Complimentary 30-minute call

Talk it through with Dr. Neeraj.

Tell us where your facility is today and where you want it to be. You leave the call with a clear next step.

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